Introduction to mental

Health Nursing

Mr. Johny Kutty Joseph

Asstt. Professor
SMVDCoN
Mental Health
A state of emotional, psychological and
social wellness evidenced by satisfying
interpersonal relationships, effective behavior
and coping, positive self-concept and
emotional stability. (WHO)
A simultaneous success at working,
loving and creating with the capacity for
mature and flexible resolution of conflicts
between instincts, conscience, important other
people and reality.
Components of Mental
Health
The ability to accept self.
The capacity to feel right towards others.
The ability to fulfill life’s tasks.
Indicators of Mental Health
 A positive attitude towards self.
Growth, development and the ability for self
actualization.
Integration
Autonomy
Perception of Reality.
Environmental Mastery.
 Characteristics of Mentally

Healthy Person
An ability to make adjustments.
Sense of personal worth, and importance.
Own decision making and problem solving.
Sense of personal security and feel secure in group,
understand other people problems and motives.
Sense of responsibility.
Give and accept love.
Shows emotional maturity and tolerate frustration.
Have a philosophy of life and purpose to his daily
activities.
Has a variety of interests and well balanced with
work, rest and recreation.
Lives in the world of reality not fantasy.
Mental Illness
Mental and behavioral disorders are
clinically significant conditions characterized
by alterations in thinking, mood/emotions, or
behaviour associated with personal distress
and impaired functioning.
Characteristics;
1.Change in thinking, memory, perception,
feeling, judgment and speech.
2.Disturbance in day to day activities, work and
relationship with important others.
Evolution of Mental Health
The disease was viewed by demonic
possession, influence of ancestral spirits,
result of violating a taboo, neglecting ritual
and cultural condemnation.
As a result they were beaten, tortured, to
make body unsuitable for demon.
Evolution of Mental Health
The scientific knowledge and truth begins.
 Pythagoras: (580-510 BC) developed the concept
that brain is the seat of intellectual activity.
 Hippocrates: (460-370 BC) described mental
illness as hysteria, mania, and depression.
 Plato (427- 347 BC) identified the relationship
between mind and body.
 Asciepiades: made simple hygienic measures,
diet, bath, massage in place of mechanical restraints.
 Aristotle suggested release of repressed emotions
for the effective treatment of mental illness.
Evolution of Mental Health
The scientific knowledge and truth begins.
Renaissances in Europe on old beliefs. The
saddest period in the history of psychiatry.
Demons cause hallucinations and delusions
hence chain the patients.
Some Important Milestones
1773: The first mental hospital was set up
in US, Virginia.
1793: Philippe Pinel removed the chains
from mentally ill patients confined in Bicetre,
Paris and brought a revolution in the country.
1812: The first American textbook in
Psychiatry was written by Benjamin Rush.
1912: Eugene Bleuler , a Swiss Psychiatrist
coined the term schizophrenia.
1912: The Indian Lunacy Act was passed.
Some Important Milestones
1927: Insulin shock treatment was
introduced for schizophrenia.
 1936: Frontal lobectomy was advocated
for the management of psychiatric conditions.
1938: Electroconvulsive Therapy (ECT)
was used for the treatment of psychosis.
1939: Development of Psychoanalytical
theory by Sigmund Freud led to new concepts
in the treatment of mental illness.
1946: The Bhore committee recommended
setting of five mental Hospitals in the Country.
Some Important Milestones
 1949: Lithium was used for the treatment of
mania.
 Chlorpromazine was introduced in
psychopharmacology.
 1963: The community mental health centers
Act was passed.
 1978: The Alma Ata declaration of Health for
All by 2000 AD posed major challenge to Indian
mental health professionals.
 1981: Community psychiatric centers were set
up to experiment primary mental health care
approach.
Some Important Milestones
 1982: The central council of health, India’s highest
policy making body accepted the National Mental
Health Policy and brought out the National Mental
Health Programme in India.
 1987: The Indian Mental Health Act was passed
and constituted Central Mental Health Authority
(CMHA) and State Mental Health Authority (SMHA).
 1990: Formation of Action Group to pool opinion
for National Mental Health Programme. Integration of
mental health care with general health care, school
mental programme, promotion of child mental health,
crisis intervention of suicide prevention, halfway
homes, IEC etc.
Some Important Milestones
 2001: Current situation analysis (CSA) was done to
evolve a comprehensive plan of action to energize the
NMHP.
 2007: Eleventh five year plan emphasized up
gradation and strengthening of mental health
hospitals.
 2013: WHO launched Mental Health Action Plan
2013-2020.
 2013: The Mental Health Care Bill was introduced .
The bill abolishes the Mental Health Act 1987.
 2014: Government constituted a committee to
create policy for the country.
 Some Important Milestones
in Mental Health Nursing
 1872: First training school for nurses based on
the Nightingale system was established by the New
England Hospital, USA.
 1921: Short training courses of 3 to 6 months
were conducted in Ranchi.
 1943: Psychiatric nursing was started for male
nurses. (Tamil Nadu)
 1952: Dr. Hildegard Peplau defined the
therapeutic roles of nurses in mental health setting.
 1953: Maxwell Jones introduced therapeutic
community.
 Some Important Milestones
in Mental Health Nursing
 1956: One year post- certificate course in psychiatric
nursing was started at NIMHANS.
 1958: All the wards in Agra Mental Hospital were
ordered to be kept open and all ward locks were removed
from the charge of the ward attendant.
 1963: Journal of Psychiatric Nursing and Mental
Health services was published.
 1965: The Indian Nursing Council included
psychiatric nurse as a compulsory course in B.Sc
Nursing Programme.
 1967: The TNAI formed a separate committee to set
guidelines to conduct classes and clinical training for
nursing students.
Some Important Milestones
in Mental Health Nursing
1973: Standards of Psychiatric and Mental
Health Nursing Practice were enunciated to
provide a means of improving the quality of
care.
1975: M.Sc in Psychiatric Nursing started.
1986: Psychiatric nursing was included in
GNM.
1991: Indian Society of Psychiatric Nurses
started.
2010: ISPN published its journal.
 Indian Society of Psychiatric
Nurses
 ISPN started in the year 1991 at NIMHANS under the
guidance of Dr. Reddemma.
Purpose
 To enhance the advanced knowledge and skills in the
field of psychiatric nursing.
 To provide a platform for discussion and deliberation
on evidence based practice.
 To create awareness and translate the research
finding into practice.
 ISPN publishes a journal called Indian Journal of
Psychiatric Nurses.
 It also Organizes National and International
conferences.
Current Issues and Trends Care
1. Trends in Health Care:
 Increased mental problems.
 Provision of quality and comprehensive
services.
 Multi-disciplinary team approach.
 Providing continuity of care.
 Care is provided in alternative settings.

2. Economic Issues
 Industrialization
 Urbanization
 Raised standard of living.
Current Issues and Trends Care
3. Changes in the Illness Orientation
Shift from Illness to prevention.
Quantity of care to quality of care.
Specific to holistic care.

4. Changes in the Care delivery

Institutional services to community
services.
Genetic to counseling services.
Nurse patient relationship to nurse patient
partnership.
Current Issues and Trends Care
5. Information Technology
 Telenursing
 Telemedicine
 Mass media
 Electronic Systems.
 Nursing Informatics.

6. Consumer Empowerment
 Increased consumer awareness.
 Increased community awareness.
 Demand health care at affordable cost and
more humane rates.
Current Issues and Trends Care
7. Deinstitutionnalization
 Shifting Mental Health care from hospital to
Community.
8. Physician Shortage and Gaps in service.
 Physician shortage provide opportunity for new
roles in nursing such as Nurse Practioner.
9. Demographic Changes
 Increasing number of elderly group.
 Type of family.

10. Social Changes

 Intergroup and intragroup loyalty maintenance.
 Peer Pressure.
Future Prospects and Challenges
in Psychiatric Nursing
 There is a lack of clearly enunciated
definition of the role of a professional
psychiatric nurses.
 Greater emphasis to encourage master
degree in psychiatric nursing to encourage
teaching non-professionals.
 Offer diploma in psychiatric nursing to
avoid shortage of trained professionals.
 Maintain minimum standards of psychiatric
nursing care in mental hospitals ie, 1:3.
Future Prospects and Challenges
in Psychiatric Nursing
 Fillvacant positions in concerned educational and
practicing institutions.
 Integration of service and training.
 Formation of District Mental Health Team
comprising of 2 psychiatric nurses and 1 Psychiatrist.
 Integration mental health services in PHCs and
Sub centers.
 Joined working of hospitals and training centers to
build the gap of theory and practice. If not, the hospital
staff will have lack of up gradation of knowledge and
training centre staff will have lack of up gradation of
skills.
 Prevalence and Incidence of
Mental Health problems
The recent prevalence of psychiatric
disorders in the country is 18 – 207 per 1000
population and the world scenario is also
almost the same.
Most of these patients live in rural areas.
Most of the time the person visiting a
general clinic is not diagnosed for his mental
problems rather other diagnosis is made which
cause financial burden to the patients.
 Prevalence and Incidence of
Mental Health problems
World Scenario (According epidemiological
survey by WHO in 14 countries) (a 12 months
prevalence in the year 2000-2001)
Anxiety disorders : 2.4% to 18.2%
Mood disorders: 0.8% to 9.6%
Substance disorders 0.1–6.4%
Impulse-control disorders 0.0–6.8%
 Prevalence and Incidence of
Mental Health problems
Indian scenario (According to an
epidemiological study by Ganguli HC, 2000)
 All Mental disorders 73/1000 population
(rural: 70.5 and urban 73)
 Affective disorder (depression): 34/1000
 Anxiety Neurosis: 16.5/1000
 Mental Retardation: 5.3/1000
 Schizophrenia: 2.5/1000
 According to health information of India 2005
mental morbidity rate is not less than 18-20/1000
 Prevalence and Incidence of
Mental Health problems
According to Who studies in India the life
time prevalence of mental disorders is12.2 to
48.6 %.
According Ministry of Health and Family
welfare, India, 10000 people every year suffer
from acute psychosis.
Schizophrenia and bipolar disorders is
prevalent at a rate of 200/10000 population.
This burden is likely to increase by 15% in
2020. (Ghanashyan B & Nagarathinam S)
National Mental Health Policy 2014
In April 2011 the GoI constituted a policy
group.
Based on the recommendations of the
experts The National Mental Health Policy was
considered in accordance with World Health
assembly resolution.
It incorporates an integrated, participatory
rights and evidence based approach.
National Mental Health Policy 2014
Vision
Promote mental health
Prevent mental illness
Enable recovery from mental illness.
Promote destigmatization
Promote desegregation
Provide accessible, affordable and quality
mental health and social care to all persons
through life span within right based
framework.
National Mental Health Policy 2014
Goals (Long term destination)
To reduce distress, disability, exclusion
morbidity and premature mortality associated
with mental health problems.
To enhance understanding of mental
health in the country.
To strengthen the leadership in the mental
health sector at the National, State and District
Levels.
National Mental Health Policy 2014
Objectives
(Short term steps for reaching goal.)
 To provide universal access to mental health
care.
 To increase access and utilization of
comprehensive mental health care services.
 To increase the access of the said services to
vulnerable groups including homeless, remote
areas, deprived (education, economy and socially)
sections
 To reduce prevalence and risk factors of mental
problems.
 Reduce suicide and its attempts.
National Mental Health Policy 2014
Objectives
(Short term steps for reaching goal.)
 Respect the rights of mentally people and
protect them from harms.
 Reduce stigma associated.
 Equitable distribution of skilled human
resources.
 Enhance financial allocation and utilization
in the sector.
 Identify and address the social, biological
and psychological determinants of mental
health problems.
National Mental Health Policy 2014
Strategic Actions
1. Effective governance and delivery
mechanisms for mental health
Develop policies, programmes, laws
regulations and budget.
Motivate society and other administrative
machineries to implement and monitor the
plans.
National Mental Health Policy 2014
Strategic Actions
2. Promotion of Mental Health
Redesign Anganwadi centers and train the
workers and teachers to protect children from
developing abnormal behaviour.
Offer (LSE) Life Skill Education programme
to school children.Life-Skills-Education-in-
India.pdf
Individual attention by teachers for early
symptoms.
Improve teacher student relationship for
free communication.
National Mental Health Policy 2014
Strategic Actions
2. Promotion of Mental Health
Assist adults in handling stressful life
circumstances.
Use mass media to disseminate mental
health information.
Improve life conditions such as
homelessness, overcrowding, water, toilets,
sanitation and nutrition to prevent mental
illness.
Improve women mental health and prevent
harm to women.
National Mental Health Policy 2014
Strategic Actions
2. Promotion of Mental Health
Use Ayurveda and Yoga to promote mental
Health.
Involve mentally ill people in social,
economical and other activities, do not
discriminate.
National Mental Health Policy 2014
Strategic Actions
3. Prevention of mental illness, reduction of
suicide ant attempted suicide.
Implement programs to address alcohol
and other drug abuse.
Restrict the distribution of specific drugs
and highly toxic pesticides.
Frame guidelines for media reporting
suicide.
Decriminalize attempted suicide.
Train community leaders to prevent it.
National Mental Health Policy 2014
Strategic Actions
4. Universal access to mental health services.
All multispecialty govt. hospitals should
provide family centric mental health services.
Increase community based rehabilitation
services like day care centers, short stay
facilities etc.
Caregivers should be given professional
inputs and promoted for personal growth.
Screening and early detection.
 National Mental Health Policy 2014
Strategic Actions
4. Universal access to mental health services.
Resolve shortage psychiatric beds in
hospitals.
Improve infrastructure.
Improve monetary benefits and tax benefits
to care givers.
Provide assisted home living and also care
homeless patients.
 National Mental Health Policy 2014
Strategic Actions
5. Availability of Trained professionals
Reduce the gap between requirement and
availability of psychiatrists, nurses,
psychologists etc.
Improve number and quality of the training
programmes.
Training programmes must incorporate
biomedical and psychosocial interventions in the
interventions for the patients.
 National Mental Health Policy 2014
Strategic Actions
6. Community participation for mental health
and development.
Simplify procedures for disability certification
of persons with mental illness.
Protect the rights of mentally ill and modify the
legislations accordingly.
Promote participation in life activities of
mentally ill such as education, housing,
employment and social welfare.
Involve them in community programmes such
as village health, sanitation, water etc and public
activities.
National Mental Health Policy 2014
Strategic Actions
6. Community participation for mental health
and development.
Provide opportunity for mentally ill for
feedback in mental health services.
 National Mental Health Policy 2014
Strategic Actions
7. Research
More investment and fund allocation in
building research capacity for both new and
existing organizations.
Foster partnership between centers of
excellence for mental health and medical colleges
and district centers to promote research.
Evaluate the potential of traditional, alternative
therapies to address mental health problems.
Facilitate dissemination of research findings
and translate it into action.
 National Health Policy
NHP formulated in 1983 and revised in 2002.
Objectives
To achieve an acceptable standard of good
health amongst the general population.
Increase approach to decentralized public
health system.
Establish new infrastructure and update
existing infrastructure.
 National Health Policy
Specific Recommendations for Mental Health
Upgrade infrastructure of institutions at
central government expense to protect the rights
of vulnerable group of the society.
Promote decentralization of mental health
services for more common categories of
disorders.